LPHSA: St. Louis County, MO Vignette

Using Public Health Frameworks to Improve Activities

The St. Louis County Department of Health (SLCDOH) serves a large urban and suburban geographic area surrounding the City of St. Louis. St. Louis County consists of 524 square miles of land, approximately one million persons, 92 municipalities, and 24 school districts. In 1997, SLCDOH embarked on the "In-Partnership" process to assist in more accurately and effectively assessing and serving the communities in the area. A collaborative community health planning process with the Jennings community and an internal core functions based training process (which included ongoing collaborative activities with distinct communities in the county) were implemented. A key concept in both of these activities was a focus on the "community-oriented core public health functions," or engaging the community in all aspects of the core public health functions.

To strengthen the ability of SLCDOH staff in empowering and engaging the community, approximately 50 staff were recruited to participate in an internal training. In partnership with the National Civic League, a series of training sessions was designed to progressively educate staff about both the core functions and skills required for empowering and engaging the community. As one step in the training, staff formed four cross-disciplinary teams focusing on poverty, communicable disease, healthy neighborhoods, and family health. Each team is working with a community identified by an assessment step to address a problem in their issue area. For example, the family health team narrowed its focus to address limited utilization of preventive care services among the 30-60 year-old individuals. This team is working with the community to explore how to promote increased use of preventive services and earlier detection.

While the process is still underway, the benefits of these activities are already apparent. Identified progress has been made toward one of the primary goals of the project — to have staff "think differently" and more strategically and to change mind sets to focus on community needs based on assessment and community inclusion. Staff have a better understanding of the public health infrastructure, interactive roles they play, and how their activities relate to assuring public health as a whole. The cross-disciplinary aspect of the teams was especially useful in building bridges and communication between employees and divisions. The staff and the community are learning to better understand each other and are strengthening the capacity of SLCDOH to respond to problems collaboratively.

The changing mind sets are improving the work being done by SLCDOH. For example, the Environmental Health Division has traditionally had a strong regulatory focus. The training process has helped to make inspections more community-friendly, adding the dimensions of learning experiences and community responsiveness. Additionally, SLCDOH has developed a public health orientation packet and instituted a mentoring program for new employees. Furthermore, a consultant with the St. Louis University has developed a survey related to the Essential Services to explore the activities, behaviors, and attitudes of employees. Although it had not yet been implemented at the time of the case study, it is apparent that this will be another useful tool for improving SLCDOH's broad-based approach. This training initiative continues, with plans to repeat the cycle for another class of interdisciplinary and vertically integrated employees from throughout the department.